title: Randomized controlled trial comparing hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy.
abstract: BACKGROUND
  Laparoscopic donor nephrectomy (LDN) has become the gold standard for live-donor nephrectomy, as it results in a short convalescence time and increased quality of life. However, intraoperative safety has been debated, as severe complications occur incidentally. Hand-assisted retroperitoneoscopic donor nephrectomy (HARP) is an alternative approach, combining the safety of hand-guided surgery with the benefits of endoscopic techniques and retroperitoneal access. We assessed the best approach to optimize donors' quality of life and safety.
  
  
  METHODS
  In two tertiary referral centers, donors undergoing left-sided nephrectomy were randomly assigned to HARP or LDN. Primary endpoint was physical function, one of the dimensions of the Short Form-36 questionnaire on quality of life, at 1 month postoperatively. Secondary endpoints included intraoperative events and operation times. Follow-up was 1 year.
  
  
  RESULTS
  In total, 190 donors were randomized. Physical function at 1 month follow-up did not significantly differ between groups (estimated difference, 1.79; 95% confidence interval, -4.1 to 7.68; P=0.55). HARP resulted in significantly shorter skin-to-skin time (mean, 159 vs. 188 min; P<0.001), shorter warm ischemia time (2 vs. 5 min; P<0.001) and a lower intraoperative event rate (5% vs. 11%, P=0.117). Length of stay (both 3 days; P=0.135) and postoperative complication rate (8% vs. 8%; P=1.00) were not significantly different. Potential graft-related complications did not significantly differ (6% vs. 13%; P=0.137).
  
  
  CONCLUSIONS
  Compared with LDN, left-sided HARP leads to similar quality of life, shorter operating time, and warm ischemia time. Therefore, we recommend HARP as a valuable alternative to the laparoscopic approach for left-sided donor nephrectomy.
authors.affiliation: 1 Department of Surgery, Division of Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. 2 Department of Urology, Radboud University Nijmegen Medical Center, The Netherlands. 3 Department of Internal Medicine, Division of Nephrology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. 4 Department of Nephrology, Radboud University Nijmegen Medical Center, The Netherlands. 5 Address correspondence to: Jan N.M. IJzermans, M.D., Ph.D., Department of Surgery, Division of Transplant Surgery, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Leonienke F C
authors.initials: LF
authors.lastname: Dols
authors.forename: Niels F M
authors.initials: NF
authors.lastname: Kok
authors.forename: Frank C H
authors.initials: FC
authors.lastname: d'Ancona
authors.forename: Karel W J
authors.initials: KW
authors.lastname: Klop
authors.forename: T C Khe
authors.initials: TC
authors.lastname: Tran
authors.forename: Johan F
authors.initials: JF
authors.lastname: Langenhuijsen
authors.forename: Türkan
authors.initials: T
authors.lastname: Terkivatan
authors.forename: Frank J M F
authors.initials: FJ
authors.lastname: Dor
authors.forename: Willem
authors.initials: W
authors.lastname: Weimar
authors.forename: Ine M
authors.initials: IM
authors.lastname: Dooper
authors.forename: Jan N M
authors.initials: JN
authors.lastname: Ijzermans
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011788:Quality of Life; D012187:Retroperitoneal Space; D052096:Warm Ischemia